不同剂量甘露醇在脑出血治疗中的应用

Mannitol dosage in treatment of intracerebral haemorrhage

目的分析不同剂量甘露醇在脑出血治疗中的综合效益。方法选择2012年1月~2013年12月,我院急诊收治高血压性脑出血患者82例其中以半剂量甘露醇治疗患者38例纳入半剂量组,以全剂量甘露醇治疗44例纳入全剂量组。均给予内科保守治疗,给予甘露醇、营养支持与对症治疗。分别在入院次日、停用甘露醇当日测肾功能、血离;入院时、治疗后14d行神经功能缺损评分评估（ME-SS）、血肿大小。就ME-SS水平、血肿大小变化、指标异常率进行组间、组内对比。结果组内与组间对比,神经功能缺损评分变化与血肿扩大率差异无统计学意义（P〉0.05）;全剂量组减量停用好转率55.56%高于直接停用者17.65%,差异具有统计学意义（P〈0.05）;治疗后半剂量组,全剂量组中减量停用、直接停用、合计者肾功能、尿常规、离子水平异常率高于治疗前,全剂量组直接停用者肾功能、尿常规、离子水平异常率分别为47.06%、47.06%、52.94%高于减量停用14.81%、7.41%、18.52%,全剂量组27.27%、22.73%、31.82%高于半剂量组7.89%、13.16%、15.79%,差异具有统计学意义（P〈0.05）。结论脑出血应用甘露醇后仍可能发生血肿扩大,不同患者疗效差异较大;全程全剂量水平、多频次给予甘露醇改善患者预后效果不显著,也不能有效遏制血肿扩大,全程全剂量使用还可能增加毒理作用;初始应用全剂量甘露醇,而后进行调整应用,有助于降低不良反应发生风险,且患者预后更好。

Objective To investigate the effects of different doses of mannitol on intracerebral haemorrhage. Methods Eighty-two patients with supratentorial hypertensive intracerebral haemorrhage who were admitted to our hospital from January 2012 to December 2013 were included in the study. Thirty-eight patients received a half dose of mannitol and the others received a full dose. All patients were treated with conservative medical therapy, mannitol, nutritional support, and symptomatic treatment. Renal function and blood samples were tested before and after treatment. Modified Edinburgh-Scandinavia Stroke Scale （MESSS） and haematoma volume were evaluated before and after 14 days of treatment. Differences in MESSS, haematoma volume, and abnormal rate between and within groups were statistically analyzed. Results There were no significant differences in MESSS and haematoma volume between and within groups （P〉0.05）. In the full-dose group, patients with gradual mannitol withdrawal had a significantly higher recovery rate than those with abrupt mannitol withdrawal （55.56% vs 17.65%, P〈0.05）. For both groups, abnormal rates in renal function, urine test, and ion level were significantly higher before treatment than after treatment. In the full-dose group, patients with abrupt mannitol withdrawal had significantly higher abnormal rates in renal function, urine test, and ion level than those with gradual mannitol withdrawal （47.06% vs 14.81%, P〈0.05; 47.06% vs 7.41%, P〈0.05; 52.94% vs 18.52%, P〈 0.05）. Compared with the half-dose group, the full-dose group had significantly higher abnormal rates in renal function, urine test, and ion level （27.27% vs 7.89%, P〈0.05; 22.73% vs 13.16%, P〈0.05; 31.82% vs 15.79%, P〈0.05）. Conclusion The clinical efficacy of mannitol for treating intracerebral haemorrhage varies a lot among patients. Mannitol therapy still possibly results in a larger haematoma volume. A full dose of mannitol frequently given over the whole treatment period is not an optimal therapy for patients due to insignificant improvement in prognosis, ineffective control of haematoma volume, and potential toxicity. To reduce the risk of adverse reactions and improve the prognosis,the mannitol dose should be full in the initial treatment of intracerebral haemorrhage and modified afterwards.